Thrombophilia and collagen disease in ART

s.SalehpourAssociate professor. SBMU

Medical DirectorIVF Center.

Taleghani Hospital.Autumn 2014-Tehran university

- Incidence of Thrombophilia: 1.6/100000- Major complication in IVF cycle:

thromboembolism- COH→ Protein C resistance→ DVT- HCG injection → ↑ Factor II, V, vII, vIII, Ix

( Last 3 weeks after pregnancy)

Indication for thrombophilia screening beforeIVF:

- recurrent miscarriage- RIF- hx of VTE - hx of OHSS- Serious infection - Immobilization

Management of thrombophilia during IVF:

SLE and APS:Fertility is normal in SLE and APS except in:

- Amenorrhea- Renal insufficiency related subfertility- ovarian failure due to

cyclophosphamide

COH→↑ estrogen thombosis exacerbation of disease

Safe COH:1- SLE in Remission (6-12 months after last flare)

2- NO deep organ involvement3- NO APS or low titer4- Prophylactic anti coagulant5- Prophylactic anti inflammatory6- low dose Aspirin

Special considerations in ART for SLE and APS:

- avoid OCP- Mild Stimulation- Prevent OHSS- SET

LPS in SLE and APS

- Progesterone better than HCG- Vaginal progesterone better than oral

(Hepatic first pass)

Pregnancy and SLE and APS- Flare of SLE- deterioration of Renal function- ↑ thrombosis- ↑ miscarriage- ↑ IUFD- ↑ PIH/preeclampsia- ↑ IUGR- ↑ PRETERM LABOR- ↑ congenital heart block

Discourage pregnancy in:

- bad arterial hypertension- Pulmonary hypertension- Advanced Renal disease- Severe heart disease- previous thrombotic events.